WIPA Eligible or Not?

January 2016

Individuals must meet the following criteria to be eligible for WIPAservices:

•At least age 14, but not yet full retirementage1,

•Disabled per Social Security’s definition,and

•Already receiving (or approved to receive) Social Security benefits based on disability (SSI or a TitleII disability benefit such as SSDI, CDB or DWB),or

•Receiving continued Medicaid under1619(b) of the Social Security Act,or

•Receiving only SSI State supplementary payment,or

•Receiving Medicare under the Extended Period of Medicare Coverage as a former beneficiary of the Title II disabilityprograms (SSDI, CDB, DWB) or as a Medicare Qualified Government Employee who received Medicare based ondisability.

1NOTE: Full Retirement Age (FRA) varies depending when individuals were born. Toidentifythe FRA for various birth dates, go to POMS RS 00615.003 Full Retirement Age at , or search for “full retirement age” or normal retirement age”on

Eligible for WIPA Services

  • Individuals receiving SSI benefits due to disability who are in cash payment status. This includes persons who only receive state supplement payments. Individuals receiving Title II benefits based on disability (SSDI, CDB, DWB) who are in cash payment status.
  • Individuals who have lost cash SSI payments due to work, but are considered SSI eligible due to eligibility for 1619(b) extended Medicaid.
  • Individuals who have lost Title II disability cash payments due to work, but are still in the Extended Period of Eligibility (EPE).
  • Title II disability beneficiaries who have received initial notice that Social Security considers them to be engaging in SGA.
  • Individuals who have lost Title II disability benefits due to SGA-level employment, but are still receiving Medicare through the Extended Period of Medicare Coverage (EPMC). Individuals who have received notice of approval for Title II disability benefits, but are still in the 5-month waiting period before payments may begin.
  • SSI recipients and Title II disability beneficiaries who have completed the disability determination process and are receiving benefits under Expedited Reinstatement.
  • Individuals who continue to receive CDB payments due to disability after full retirement age.

Ineligible for WIPA Services

  • Individuals with disabilities who receive Medicare as Medicare Qualified Government Employees (MQGE) based on disability.
  • Individuals who have become ineligible for SSI and 1619(b) extended Medicaid.
  • Individuals who have lost SSI or Title II disability benefits due to medical recovery. Individuals age 65 or older who receive SSI due to advanced age, rather than disability.
  • Individuals who receive a Social Security Title II benefit not based on disability.
  • Individuals who receive Medicare only under the End Stage Renal Disease (ESRD) provision, but who haven’t established entitlement for Title II disability benefits.
  • SSI recipients and Title II disability beneficiaries receiving continued disability benefits in spite of medical recovery under section 301 provisions.
  • Individuals only receiving other federal, state or local benefits (other than SSI State supplementary payments) who aren’t also entitled to Social Security benefits based on disability.
  • Individuals who have applied for Social Security disability benefits, but for whom no determination has been made.
  • SSI recipients and Title II disability beneficiaries receiving provisional benefits under Expedited Reinstatement (EXR) who haven’t completed the disability determination process (unless eligible under EPMC).
  • Individuals who are receiving cash payments (SSI or Title II) while appealing an adverse medical determination.

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